1. State the aim clearly. Achieving agreement on the aim of a project is critical for maintaining progress. Teams make better progress when they are very specific about their aims. Make sure that the aim statement describes the system to be improved, and the patient population. In addition, ensure that the aim gives guidance on the approaches to improvement.
2. Include numerical goals that require fundamental change to the system. Teams are more successful when they have unambiguous, focused aims. Setting numerical goals clarifies the aim, helps to create tension for change, directs measurement, and focuses initial changes. For example, the aim "Reduce operating room time" is not as effective as "Reduce operating room time by 50% within 12 months." Including numerical goals not only clarifies the aim but also helps team members begin to think about what their measures of improvement will be, what initial changes they might make, and what level of support they will need.
3. Set stretch goals. A "stretch" goal is one to reach for within a certain time. Setting stretch goals such as "Reduce operating room time by 50% within 12 months" communicates immediately and clearly that maintaining the status quo is not an option. Effective leaders make it clear that the goal cannot be met by tweaking the existing system. Once this is clear, people begin to look for ways to overcome barriers and achieve the stretch goals.
4. Avoid aim drift. Once the aim has been set, the team needs to be careful not to back away from it deliberately or "drift" away from it unconsciously. The initial stretch goal "Reduce operating room time by 50% within 12 months" can slip almost imperceptibly to "Reduce operating room time by 40%" or "by 20%." To avoid drifting away from the aim, repeat the aim continually. Start each team meeting with an explicit statement of aim, for example, "Remember, we’re here to reduce operating room time by 50% within 12 months," and then review progress quantitatively over time.
5. Be prepared to refocus the aim. Every team needs to recognize when to refocus its aim. If the team’s overall aim is at a system level (for example, "Reduce adverse drug events in critical care by 30% within 12 months"), team members may find that focusing for a time on a smaller part of the system (for example, "Reduce adverse drug events for critical care patients on the cardiac service by 30% within 12 months") will help them achieve the desired system-level goal. Note: Don’t confuse aim drift, or backing away from a stretch goal (which usually isn’t a good tactic), with consciously deciding to work on a smaller part of the system (which often is a good tactic).